Medicaid Eligibility Quality Control
Since 1978, the Medicaid Eligibility Quality Control (MEQC) program has gone through several iterations. On July 5, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final regulation entitled Changes to the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) Programs (CMS-6068-F). This regulation restructured the MEQC program into an ongoing series of pilots that are closely coordinated with CMS’s Payment Error Rate Measurement (PERM) program.
Under the MEQC program, states design and conduct projects, known as pilots, to evaluate the processes that determine an individual’s eligibility for Medicaid and Children’s Health Insurance Program (CHIP) benefits. States have great flexibility in designing pilots to identify vulnerable or error-prone areas. In addition, states conduct MEQC pilots during the two-year intervals (“off-years”) that occur between their triennial PERM review years. The MEQC program does not generate an error rate.
When an MEQC pilot concludes, the state must submit to CMS both a case-level review report on the results of their pilots and a corrective action plan to address the errors and deficiencies identified through the pilot work.
On August 29, 2018, CMS released a guidance document to assist states in implementing the final regulation. CMS released updated guidance on October 22, 2018. The guidance document provides states with information about the general requirements in the regulation and detailed specifications regarding the MEQC pilot planning documents that each state is required to submit on November 1 of the year in which their PERM review is completed.